Third wave batters community, floods hospitals

Early in the morning of 28 May 2021, Lisa Kowalsky warned the Johannesburg Jewish Mommies Facebook group that there weren’t enough COVID-19 beds in Gauteng.

Her desperately ill father was unable to find a bed, and she wanted to alert people to the extent of the third wave.

“Even though we had paramedics and a doctor at the house, we couldn’t find a hospital in Joburg or Pretoria to take him to as all the beds are full,” she wrote. “You can imagine the panic and sense of helplessness we went through.

“By an absolute miracle, a high-profile doctor I’m fortunate to know managed to convince someone from one of the hospitals to make a space for him in an intensive-care unit (ICU) at one of the hospitals,” she wrote.

“What I’m trying to convey to all of you is that there are NO beds. The situation is scary and dangerous. You cannot treat this virus lightly. Do not take chances. Your life is at stake.”

Speaking to the SA Jewish Report on Monday, 31 May, Kowalsky said her father was still battling in high care and might be taken back to ICU if his oxygen levels don’t improve.

“He just wants to come home. He is a fit and healthy man, but his oxygen levels continue to go up and down. He was doing so well at first. He went for a COVID-19 test because he was due to have a procedure, otherwise he would never have known. Then two days later, he started to deteriorate.”

She said he was taken to hospital a number of times because of dehydration after vomiting, but wasn’t admitted because he wasn’t ill enough. Eventually, when he needed to be admitted, she was “horrified” when they couldn’t find a bed.

Said specialist physician pulmonologist Dr Carron Zinman of Netcare Linksfield Hospital, “What we are seeing this time round is that if somebody comes home with the virus, the vast majority of the household gets infected. We’ll also have cases where the blood work is mild, they’re getting better, and then 24 hours later, their symptoms get aggressive and we can’t turn them around.

“We’re seeing more cases under the age of 45 with no co-morbidities who are really sick. Fifty percent of our patients are in ICU, and 80% to 90% are on ventilators in one form or another. Last Monday [24 May], we had four resuscitations in two hours. Two were unsuccessful, two weren’t.”

Although Hatzolah’s numbers are specific to the Johannesburg community, the number of new cases the organisation is dealing with is going up rapidly. Last Friday, it had 123 new cases in the week with 213 patients on home oxygen (active and closed) and 349 admissions to hospital (active and closed). The week before, it had 103 new cases, with 211 on home oxygen, and 333 hospital admissions. The week before that, there were 66 new cases.

The numbers are lower in Cape Town, but that doesn’t mean the virus isn’t leaving a trail of tragedy in its wake. Fifty-year-old Bram Radowsky’s family described him as almost “paranoid” about COVID-19. But a month ago, he let his guard down a little and attended a small gathering to watch sport with friends. Two weeks later he was dead, suffering a heart attack in his sleep as a result of mild COVID-19 pneumonia.

“After the gathering, he was told that a person who was there tested positive for COVID-19,” said his brother, Gordon Radowsky. “He went into self-quarantine and didn’t have any symptoms. A week later, he tested positive and began to get symptomatic. He called an ambulance, but they said he wasn’t sick enough to be admitted. So he drove himself to hospital and checked himself in. The lesson is that if you believe you need advanced medical care, then get the help that you need urgently.

“At no stage did any of us think we would lose him,” said their mother, Rose Radowsky (80). “He was overweight but had no other co-morbidities. He was in ICU on oxygen. On the Saturday [after a week in hospital], the ward sister said they were pleased with his progress. But on the Sunday morning, they called to tell us he had had a heart attack and they couldn’t resuscitate him.” Losing a child to the pandemic has been “a terrible shock”, and she is still reeling.

Virology expert Professor Barry Schoub confirmed that the country was entering a third wave of COVID-19. “Some provinces have been more seriously affected than others,” Schoub said. “The third wave was predicted to coincide with the winter months, when people are reluctant to be outdoors, or to open doors and windows to improve ventilation in indoor settings.”

Dr Darren Joseph, a specialist physician and pulmonology fellow in the department of internal medicine at Steve Biko Academic Hospital, confirmed “bed availability is at the moment a real challenge facing both the public and private sectors”.

“Over the past few weeks, we have seen a steady and marked increase in the number of confirmed COVID-19 cases as well as in the proportion of PUI [person under investigation] patients that ultimately test positive. This is in both public and private sectors,” Joseph said.

“My hospital’s COVID-19 high care and intensive-care units are near full capacity and additional wards are in the process of being reopened to facilitate more critically ill patients,” he said. “The profile of patient we are admitting remains incredibly varied. Sadly, this includes the admission of young patients with no known prior illnesses.

“It’s heart-breaking that the third wave has arrived before many of the vulnerable in our communities have had the opportunity to receive vaccinations,” he said. “Many of us are still emotionally and physically fatigued by previous waves. We are also seeing patients now who return several months after their illness with persistent symptoms and functional impairment. These after-effects are something I feel people don’t truly appreciate.”

Johannesburg general practitioner (GP) Dr Sheri Fanaroff said, “In the third wave, we are seeing much more school children being infected, especially in the high school age group, many of them infected out of the school setting.

“What is worrying about this is that although teens generally experience mild disease, they then go home and infect parents in their 50s who are much more vulnerable,” Fanaroff said.

“I have 10 patients I’m monitoring at the moment, which is a lot for my very small practice. I haven’t had anywhere close to this number since the second wave. Two are on oxygen at home, some of the others are on cortisone and anticoagulants. Some of the patients that GPs are treating at home would have been admitted to hospital if there was more bed availability. Every day, my day starts with multiple messages and calls from patients who have been exposed to a positive patient and are now contacts.

“People are making up their own rules of quarantine and really need to follow NICD [National Institute for Communicable Diseases] protocols,” said Fanaroff. “If you have been exposed, you need to quarantine for 10 days from the contact, regardless of having a negative test during this time.”

Dr Evan Shoul, an infectious-disease specialist at Netcare Milpark Hospital in Johannesburg, said, “We have been getting more calls from other hospitals that are full and [are] sending cases through. We haven’t been able to take all the patents referred to us. We are still trying to increase wards and ICUs so that we can manage as many people as possible.”

Zinman advises the community to get vaccinated, but warns that it doesn’t mean we can become complacent.

“I know 20 people who had the vaccine and got COVID-19. The message is that the vaccine can protect you from severe COVID-19, but it doesn’t protect from getting COVID-19 and giving it to the vulnerable. We can’t change our behaviour just yet.”